System and method for clinical order rescheduling

ABSTRACT

A system and associated methods are disclosed for generating alternative scheduling for orderable administration. In one embodiment, input is received regarding proposed timing for changing a current administration schedule for a substance-based orderable associated with an established order. Based on the input, one or more options for a revised administration schedule associated with the established order are generated. The generation of the scheduling options takes into consideration a policy for maintaining a degree of commonality with the current administration schedule.

CROSS-REFERENCE TO RELATED APPLICATIONS

Not applicable.

STATEMENT REGARDING FEDERALLY SPONSORED RESEARCH OR DEVELOPMENT

Not applicable.

BACKGROUND

Providers of healthcare services, such as clinicians, prescribe orrecommend various orderables to treat ailments or conditions diagnosedin patients. Examples of categories of orderables includesubstance-based agents (such as medications or other chemical agents),medical equipment, supplies, laboratory tests, or medical services.Increasingly, clinicians are utilizing electronic order managementsystems to enter and manage orderables for their patients. One exampleof such an electronic order management system is the POWERORDERSapplication available from Cerner Corporation of North Kansas City, Mo.For instance, using such an order management system, a physician orother clinician wishing to prescribe a medication for a particularpatient may access a profile for the patient and initiate an order forthe medication, entering details for the medication order. Afterinitiating the order, the physician may “sign” the order, indicating tothe order management system to process the order. Once the order hasbeen processing in the order management system, it is electronicallydispersed to the appropriate location, such as a pharmacy. In addition,the order is maintained in the profile, which allows other clinicians toview the order as well as other orders that have been placed for thepatient.

Orders for substance-based orderables may be created by a clinician foradministration of the medication or chemical agent to a patient on an“as needed” or P.R.N. basis, or alternatively, on a scheduled basis. Asillustrative examples of scheduled orderables, a physician may prescribean antibiotic to be taken once or twice a day for a certain number ofdays to treat an infection, or a chemotherapy agent to be taken over aperiod of time to kill cancerous cells. One difficulty with scheduledorderables is how to compensate when a dose is not administered at thetime scheduled. A clinician may have created a B.I.D. order schedule(twice-a-day administration) so that a medication is received, forinstance, around the time a hospitalized patient eats their morning andevening meals. If another clinician or aide fails to administer themedication dose at the scheduled time (or administers the medication toosoon), future scheduled administration times may need to be altered toensure the patient receives the therapeutic effect from the medicationthat was intended by the prescribing clinician.

However, with certain medications or chemical agents, and sometimesdependant upon the conditions they are intended to treat, altering anadministration schedule for these substance-based orderables can havesignificant negative consequences for the patient. For instance, if ascheduled administration of a chemotherapy agent is missed, or a patientmust alter the time of the day they normally receive a chemotherapydose, it may or may not be prudent (e.g., according to a standard ofcare protocol) to administer the dose immediately when it is noticedthat the scheduled time has passed or a new scheduled time has arisen.Additionally, these changes may alter the total length of time for theorder, which may be undesirable if the substance-based orderable (suchas a chemotherapy agent) is only supposed to be present within thepatient's body for a set period of time.

The difficulty in altering administration schedules for substance-basedorders is further complicated since a scheduling for an order may bealtered in a number of ways, only some of which present a strongopportunity for maintaining the originally intended therapeutic effectfor the patient. It can be difficult for clinicians to consider all ofthe scheduling options simultaneously. Specifically, it is difficult toeasily comprehend how the schedule for administration of orderablescompares across the revised scheduling options, and what particularvariations from the originally intended administration schedule resultif a particular revised scheduling option is selected.

BRIEF SUMMARY

A system and associated methods of the present invention enable thegeneration and presentation of scheduling options for a clinical order.In particular, certain embodiments focus on alternative scheduling forthe administration of orderables to a patient in association with anestablished or preexisting clinical order.

In one aspect, a computerized method is provided for generatingalternative scheduling for orderable administration. According to themethod, input is received regarding proposed timing for changing acurrent administration schedule for a substance-based orderableassociated with an established order. Based on the input, one or moreoptions for a revised administration schedule associated with theestablished order are generated. The revised administration scheduleoptions include a next administration for the substance-based orderableand a corresponding remaining administration schedule. Additionally, thegeneration of the scheduling options takes into consideration a policyfor maintaining a degree of commonality with the current administrationschedule. Thereafter, a graphical representation of the one or morescheduling options is displayed to provide a clinician the ability toreview the parameters of the generated scheduling options.

In another aspect, a computerized method for generating alternativescheduling for orderable administration utilizes certain policies inestablishing one or more options for a revised administration schedule.More specifically, the method includes receiving input regardingproposed timing for changing a current administration scheduleassociated with a established order, and thereafter determining one ormore options for a revised administration schedule associated with theestablished order, each of the options being associated with one of thepolicies. The policies may include: (a) maintaining the remaining numberof doses of the substance-based orderable to be administered under thecurrent administration schedule associated with the established order;(b) maintaining the remaining number of doses of the substance-basedorderable to be administered under the current administration scheduleassociated with the established order while observing a stop date andtime for administration of the substance-based orderable that is asclose as possible to a current stop date and time under the currentadministration schedule associated with the established order; and (c)observing a stop date and time for administration of the substance-basedorderable that represents temporal proximity with a stop date and timeunder the current administration schedule associated with theestablished order.

The system and associated methods of the present invention provide anindication of the time-based parameters surrounding individualscheduling options for orderables, enabling a clinician to quicklycontrast the scheduling options and determine which option presents thebest opportunity for treating the particular patient's condition andachieving positive health outcomes.

Additional advantages and features of the invention will be set forth inpart in a description which follows, and in part will become apparent tothose skilled in the art upon examination of the following, or may belearned by practice of the invention.

BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWING

The present invention is described in detail below with reference to theattached drawing figures, wherein:

FIG. 1 is a block diagram of an exemplary computing system environmentsuitable for use in implementing the present invention;

FIG. 2 depicts a flow diagram representative of one method forpresenting options for orderable administration schedules asalternatives to a current orderable administration schedule and updatingan order according to the option selected;

FIGS. 3A, 3B and 3C depict a flow diagram representative of one processfor establishing one or more next dose options and associated revisedorderable administration schedules;

FIG. 4 is an exemplary screen display showing a graphical representationof a current orderable administration schedule and a dosage timeselection area; and

FIG. 5 is an exemplary screen display showing a graphical representationof current and proposed orderable administration schedules based oninput received in the dosage time selection area.

DETAILED DESCRIPTION

Embodiments of the present invention relate to the establishment ofscheduling options to modify administration times associated with anexisting clinical order. Specifically, certain embodiments are concernedwith substance-based orderables, such as medications and other chemicalagents that are taken by a patient on a scheduled basis for a desiredtherapeutic effect and are thus described for explanation purposes inthe context of doses or dosage administration. The modified or revisedadministration schedule options accounts for certain policies relatingto a goal of maintaining some of the characteristics of a currentadministration schedule for an orderable. For instance, these policiesmay include maintaining the remaining number of orderable doses in thecurrent administration schedule and/or observing an orderableadministration stop date and time that is temporally proximal with acurrent stop date and time of the current administration schedule. Inone embodiment, the revised administration schedule options arepresented in a graphical display along with the current administrationschedule, and may be plotted over a timeline as display objectsrepresenting specific times for administration of the orderable underthe respective administration schedule. Additionally, the scheduleoptions may be selectable to associate the desired administrationschedule with the existing clinical order.

General Computing System Environment

Referring to the drawings in general, and initially to FIG. 1 inparticular, an example of a suitable computing system environment inwhich the invention may be implemented, for instance, a medicalinformation computing system, is illustrated and designated generally asreference numeral 20. It will be understood and appreciated by those ofordinary skill in the art that the illustrated medical informationcomputing system environment 20 is merely an example of one suitablecomputing environment and is not intended to suggest any limitation asto the scope of use or functionality of the invention. Neither shouldthe medical information computing system environment 20 be interpretedas having any dependency or requirement relating to any single componentor combination of components illustrated therein.

The present invention may be operational with numerous other generalpurpose or special purpose computing system environments orconfigurations. Examples of well-known computing systems, environments,and/or configurations that may be suitable for use with the presentinvention include, by way of example only, personal computers, servercomputers, hand-held or laptop devices, multiprocessor systems,microprocessor-based systems, set top boxes, programmable consumerelectronics, network PCs, minicomputers, mainframe computers,distributed computing environments that include any of theabove-mentioned systems or devices, and the like.

The present invention may be described in the general context ofcomputer-executable instructions, such as program modules, beingexecuted by a computer. Generally, program modules include, but are notlimited to, routines, programs, objects, components, and data structuresthat perform particular tasks or implement particular abstract datatypes. The present invention may also be practiced in distributedcomputing environments where tasks are performed by remote processingdevices that are linked through a communications network. In adistributed computing environment, program modules may be located inlocal and/or remote computer storage media including, by way of exampleonly, memory storage devices.

With continued reference to FIG. 1, the exemplary medical informationcomputing system environment 20 includes a general purpose computingdevice in the form of a control server 22. Components of the controlserver 22 may include, without limitation, a processing unit, internalsystem memory, and a suitable system bus for coupling various systemcomponents, including database cluster 24, with the control server 22.The system bus may be any of several types of bus structures, includinga memory bus or memory controller, a peripheral bus, and a local bus,using any of a variety of bus architectures. By way of example, and notlimitation, such architectures include Industry Standard Architecture(ISA) bus, Micro Channel Architecture (MCA) bus, Enhanced ISA (EISA)bus, Video Electronic Standards Association (VESA) local bus, andPeripheral Component Interconnect (PCI) bus, also known as Mezzaninebus.

The control server 22 typically includes therein, or has access to, avariety of computer readable media, for instance, database cluster 24.Computer readable media can be any available media that may be accessedby control server 22, and includes volatile and nonvolatile media, aswell as removable and nonremovable media. By way of example, and notlimitation, computer readable media may include computer storage mediaand communication media. Computer storage media may include, withoutlimitation, volatile and nonvolatile media, as well as removable andnonremovable media implemented in any method or technology for storageof information, such as computer readable instructions, data structures,program modules, or other data. In this regard, computer storage mediamay include, but is not limited to, RAM, ROM, EEPROM, flash memory orother memory technology, CD-ROM, digital versatile disks (DVDs) or otheroptical disk storage, magnetic cassettes, magnetic tape, magnetic diskstorage or other magnetic storage device, or any other medium which canbe used to store the desired information and which may be accessed bycontrol server 22. Communication media typically embodies computerreadable instructions, data structures, program modules, or other datain a modulated data signal, such as a carrier wave or other transportmechanism, and may include any information delivery media. As usedherein, the term “modulated data signal” refers to a signal that has oneor more of its characteristics set or changed in such a manner as toencode information in the signal. By way of example, and not limitation,communication media includes wired media such as a wired network ordirect-wired connection, and wireless media such as acoustic, RF,infrared, and other wireless media. Combinations of any of the abovealso may be included within the scope of computer readable media

The computer storage media discussed above and illustrated in FIG. 1,including database cluster 24, provide storage of computer readableinstructions, data structures, program modules, and other data forcontrol server 22.

The control server 22 may operate in a computer network 26 using logicalconnections to one or more remote computers 28. Remote computers 28 maybe located at a variety of locations in a medical environment orresearch environment, for example, but not limited to, clinicallaboratories, hospitals and other inpatient settings, veterinaryenvironments, ambulatory settings, medical billing and financialoffices, administration settings, home health care environments,clinicians' offices, or any other healthcare provider or administrativesettings. Clinicians, as referred to herein, may include, but are notlimited to, a treating physician or physicians, specialists such assurgeons, radiologists and cardiologists, emergency medical technicians,physicians' assistants, nurse practitioners, nurses, nurses' aides,pharmacists, dieticians, microbiologists, laboratory experts, geneticcounselors, researchers, veterinarians, students, and the like, andaides or assistants thereto. Remote computers 28 may also be physicallylocated in non-traditional medical care environments so that the entirehealth care community may be capable of integration on the network.Remote computers 28 may be personal computers, servers, routers, networkPCs, personal digital assistants (PDA), peer devices, other commonnetwork nodes, or the like, and may include some or all of the elementsdescribed above in relation to the control server 22.

Exemplary computer networks 26 may include, without limitation, localarea networks (LANs) and/or wide area networks (WANs). Such networkingenvironments are commonplace in offices, enterprise-wide computernetworks, intranets, and the Internet. When utilized in a WAN networkingenvironment, the control server 22 may include a modem or other meansfor establishing communications over the WAN, such as the Internet. In anetworked environment, program modules or portions thereof may be storedin the control server 22, in the database cluster 24, or on any of theremote computers 28. For example, and not by way of limitation, variousapplication programs may reside on the memory associated with any one orall of the remote computers 28. It will be appreciated by those ofordinary skill in the art that the network connections shown areexemplary and other means of establishing a communications link betweenthe computers (e.g., control server 22 and remote computers 28) may beutilized.

In operation, a user may enter commands and information into the controlserver 22 or convey the commands and information to the control server22 via one or more of the remote computers 28 through input devices,such as a keyboard, a pointing device (commonly referred to as a mouse),a trackball, or a touch pad. Other input devices may include, withoutlimitation, microphones, satellite dishes, scanners, or the like. Thecontrol server 22 and/or remote computers 28 may include otherperipheral output devices, such as speakers and a printer.

Although many other internal components of the control server 22 and theremote computers 28 are not shown, those of ordinary skill in the artwill appreciate that such components and their interconnection are wellknown. Accordingly, additional details concerning the internalconstruction of the control server 22 and the remote computers 28 arenot further disclosed herein.

Scheduling Options Generation

As referenced above, embodiments of the present invention enablealternative scheduling options for an existing clinical order to becreated. In embodiments, the scheduling options are designed to maintainthe therapeutic effect delivered by an orderable according to anexisting administration schedule when circumstances dictate a departurefrom the existing schedule such as a change in the time ofadministration on a unit-time basis (e.g., per day, per week, etc).

Turning now to FIG. 2, a flow diagram representative of a computerizedmethod for establishing selectable options for orderable administrationschedules is depicted generally as reference numeral 200. Initially, asshown at block 202 of FIG. 2, a current orderable administrationschedule associated with an existing clinical order is displayed. By wayof example, the administration schedule may be for a substance-basedorderable to be taken by a patient (orally or intravenously, forinstance) at certain time intervals per day, for a certain number ofdays. The associated clinical order may have been previously entered onan electronic order management system, or the like. At block 204, inputis received regarding proposed times for a change in the administrationschedule for the orderable. The input may include an earliest time foradministering a dose on a unit-time basis (e.g., first dose of the dayat 6:00 AM) and the number of doses to be administered per unit-time(e.g., twice a day, at regular intervals). Alternatively, the input mayinclude a set of times for administration (e.g., 6:00 AM, 12:00 PM,etc.).

As previously mentioned, a variety of reasons may necessitate changingthe timing for administration to properly deliver the care ortherapeutic benefit intended by the clinician creating the existingorder schedule. Sometimes a patient will receive a dose of the orderableat the wrong time on the administration schedule for the order, orchanges in the health status of the patient or healthcare providerresources may dictate that orderable administration must be undertakenat different time intervals or at a different time of the day. It shouldbe appreciated that a variety of other clinically relevant reasons mayalso necessitate the changing the orderable administration schedule.

The input regarding the proposed times can be utilized, at block 206, indetermining options for a next administration timing and correspondingrevised administration schedule for the orderable. In general, theseoptions implement a policy that seeks to maintain a degree ofcommonality with the current administration schedule for the existingorder, by, for instance, maintaining the remaining number of orderabledoses in the current administration schedule and/or observing anorderable administration stop date and time that is temporally. proximalwith a current stop date and time associated with the currentadministration schedule. Once these revised administration schedulingoptions (including the timing for the next dosage administration) aredetermined, then at block 208, the scheduling options are displayed on auser interface. The display may involve both a graphical representationof the revised administration schedule options (e.g., plotted over atimeline) and a textual representation of the policy associated witheach of the options. Each scheduling option may be representedgraphically through a set of display objects representing specific timesfor administration of the orderable under the respective administrationschedule.

Thereafter, at block 210, user input regarding a selection of one of therevised administration schedule options is received. Based on theparticular selection, at block 212, the existing clinical order isupdated in accordance with the selected schedule. Thus, in theelectronic order management system, the selected administration schedulefor the existing order includes, for instance, a new next doseadministration date and time, a new stop date and time for orderableadministration, and optionally, a change in the number of doses to beadministered per unit-time. Additionally, if the original start date andtime for the clinical order has not yet occurred (i.e., the order wasentered into the electronic order management system, but with a futurestart date and time for orderable administration), the selectedadministration schedule also includes a new start data and time fororderable administration.

The determination of options at step 206 for a revised orderableadministration schedule involves an underlying process 300 illustratedin FIGS. 3A-3C. Specifically, process 300 utilizes certain parameterssurrounding the current administration schedule for the existing orderto derive the new scheduling options for substance-based orderables.Beginning with block 302, the current administration schedule for anorderable is examined to determine if the corresponding start date andtime for the schedule is in the future. If the start date and time forthe current administration schedule is in the future, then at block 304,the next two dose options for a revised schedule that fall immediatelyafter the start date and time for the current administration scheduleare calculated, based on the input regarding proposed times for a changein the administration schedule. Thereafter, the process proceeds toblock 306. Alternatively, if the start date and time for the currentadministration schedule has already passed, then at block 308, the nexttwo dose options for a revised schedule that fall immediately after thecurrent date and time (regardless of the current administrationschedule) are calculated based on the input regarding the proposed timesfor changing the administration schedule. Thereafter, the processcontinues at block 306.

As an illustrative example, suppose the current time is “8:00 PM”, thecurrent administration schedule has a start date/time of “7:00 AM, Day1” for an orderable administered generally every twelve hours +/− twohours (B.I.D.), and the input received indicates proposed timing foradministration as “9:00 AM, 10:00 PM, Daily”. Accordingly, the firstdose option of the next two dose options may include a nextadministration time of “10:00 PM, Day 0”, with the remainingadministration schedule for the first dose option built off of thisparticular next dosage time. On the other hand, the second dose optionof the next two dose options may include a next administration time of“9:00 AM, Day 1”, with the remaining administration schedule for thesecond dose option built off of this particular next dosage time.

Returning to block 306, the new stop date and time for the revisedadministration schedule options (i.e., next two dose options) closest tothe current administration schedule stop date and time are determinedutilizing the frequency of orderable administration gleaned from theproposed times input. At block 310, it is determined whether each of thenext two dose options for the revised administration schedule present anassociated stop date and time that is past the current administrationschedule stop date and time. If the next two dose options each presentan associated stop date and time that is past the current administrationschedule stop date and time, then at block 312, the first dose optionsis designated as a valid option and the dosage count for the first doseoption is established at block 314 utilizing the stop date and time forthe revised administration schedule associated with the first doseoption. Thereafter, the process proceeds to block 316 of FIG. 3B.

Alternatively, at block 310, if at least one of the next two doseoptions for the revised administration schedule presents an associatedstop date and time that is prior in time to the current administrationschedule stop date and time, then at block 318, both of the first andsecond dose options are designated as valid options and thecorresponding dosage count for each dose option is established at block320 utilizing the stop date and time for the revised administrationschedules associated with the first and second dose options. The processcontinues at block 316 of FIG. 3B for the first dose option and at block322 of FIG. 3C for the second dose option.

With reference to FIG. 3B, at block 316, it is determined whether thedosage count for the first dose option is equal to the number ofremaining doses on the current administration schedule. In the casewhere the dosage count for the first dose option is equal to the numberof remaining doses on the current administration schedule, then at block324, the first dose option is displayed as the scheduling option thatmaintains the remaining number of orderable doses in the currentadministration schedule while observing an orderable administrationschedule stop date and time that is temporally proximal with a currentstop date and time associated with the current administration schedule.For instance, in the previous example in which the currentadministration schedule has a start date/time of “7:00 AM, Day 1” for anorderable administered generally every twelve hours +/− two hours(B.I.D.), and utilizing a stop date and time of “9:00 PM, Day 3”, if thefirst dose option presents timing for administration at “9:00 AM, 10:00PM, Daily”, then to maintain a degree of temporal proximity for the stopdate and time (in one example, the closest possible time), the stop dateand time for the revised schedule should be “10:00 PM, Day 3” instead of“9:00 AM Day 3 or Day 4”. Subsequent to block 324, the process reachesan endpoint shown on FIG. 3B.

Alternatively, at block 316, if the dosage count for the first doseoption is not equal to the number of remaining doses on the currentadministration schedule, then whether the dosage count for the firstdose option is greater than zero is determined at block 326. A situationwhere the dosage count is greater than zero causes the first dose optionto be displayed as the scheduling option that observes an orderableadministration schedule stop date and time that is temporally proximalwith a current stop date and time associated with the currentadministration schedule, at block 328. The difference between the dosagecount for the first dose option and the dosage count for the remainingportion (i.e., the remaining doses) of the current administrationschedule is indicated at block 330. Thereafter, the process moves toblock 332. Returning to block 326, in a situation where the dosage countis equal to zero, on the other hand, the process moves directly to block332.

The first dose option is utilized at block 332 to calculate another stopdate and time for the revised administration schedule where the dosagecount for the first dose option (as modified) would be a number equal tothe number of remaining orderable doses in the current administrationschedule. Thereafter, at block 334, the modified first dose option isdisplayed as the scheduling option that maintains the remaining numberof orderable doses in the current administration schedule. The processthen reaches the endpoint shown on FIG. 3B.

In FIG. 3C, the steps of process 300 represented perform the samefunction as the steps of process 300 represented in FIG. 3B, except thatthe portion of process 300 depicted in FIG. 3C is concerned with thesecond dose option as opposed to the first dose option in FIG. 3B.Turing to block 322, it is determined whether the dosage count for thesecond dose option is equal to the number of remaining doses on thecurrent administration schedule. In the case where the dosage count forthe second dose option is equal to the number of remaining doses on thecurrent administration schedule, then at block 336, the second doseoption for an orderable administration schedule is displayed as thescheduling option that maintains the remaining number of orderable dosesin the current administration schedule while observing an orderableadministration schedule stop date and time that is temporally proximalwith a current stop date and time associated with the currentadministration schedule. Subsequent to block 336, the process reaches anendpoint shown on FIG. 3C.

Alternatively, at block 322, if the dosage count for the second doseoption is not equal to the number of remaining doses on the currentadministration schedule, then whether the dosage count for the seconddose option is greater than zero is determined at block 338. A situationwhere the dosage count is greater than zero causes the second doseoption to be displayed as the scheduling option that observes anorderable administration schedule stop date and time that is temporallyproximal with a current stop date and time associated with the currentadministration schedule, at block 340. The difference between the dosagecount for the second dose option and the dosage count for the remainingportion of the current administration schedule is indicated at block342. Thereafter, the process moves to block 344. Returning to block 338,in a situation where the dosage count is equal to zero, on the otherhand, the process moves directly to block 344.

The second dose option is utilized at block 344 to calculate anotherstop date and time for the revised administration schedule where thedosage count for the second dose option (as modified) would be a numberequal to the number of remaining orderable doses in the currentadministration schedule. Thereafter, at block 346, the modified seconddose option is displayed as the scheduling option that maintains theremaining number of orderable doses in the current administrationschedule. The process then reaches the endpoint shown on FIG. 3C.

One exemplary screen display 400 showing the presentation of a currentorderable administration schedule for an existing order is illustratedin FIG. 4. The screen display 400 has a first region 402 where currentadministration schedule information is provided, such as the daily timesfor administration of the listed substance-based orderable (e.g.,Acetaminophen with Codeine), the start date and time for the existingorder, and the number of remaining doses for the current schedule. In asecond region 404, dosage time selectors 406 enable a user to inputdesired times for administration so that alternative scheduling fororderable administration may be generated. In one embodiment, the numberof dosage time selectors 406 is equal to the number of current orderableadministrations per-unit time under the current administration schedule.Therefore, if existing order is valid for administration twice a day,then two dosage time selectors 406 are presented. In an alternativeembodiment, one dosage time selector may be presented along with aselector for the number of doses per unit time, so that the user canenter an earliest orderable administration time per unit time (e.g.,first daily dose) along with a quantity of doses to be administered atregular intervals. Shown in a third region 408 is a graphical plottingof a set of display objects 410 on a timeline. Each display object 410represents an orderable administration date and time under the currentadministration schedule.

Another exemplary screen display 500 is illustrated in FIG. 5. Screendisplay 500 presents the current orderable administration schedule foran existing order along with options for revised medicationadministration schedules based on the input to a set of dosage timeselectors 506. In additional to a first display region 502 providingcurrent administration schedule information, and a second display region504 where the dosage time selectors 506 are disposed, a third displayregion 508 includes a graphical plotting of sets of display objects 510for the current administration schedule as well as the options forrevised administration schedules. As with the display objects 410 ofFIG. 4, the display objects 510 represent orderable administration datesand times for the respective administration schedule. In the case whereone option for an administration schedule is keeping with the policy ofobserving an orderable administration schedule stop date and time thatis temporally proximal with a current stop date and time associated withthe current administration schedule, a notification 512 is provided thatthe associated schedule option provides for one additional dosage of theorderable as compared to the number of remaining doses on the currentadministration schedule. A fourth display region 514 of the screendisplay 500 includes textual representations of the policy associatedwith each of the options for a revised administration schedule. Optionselectors 516 are located in proximity to each of the textualrepresentations, such that a user may select a particular selector 516associated with one of the options for a revised administrationschedule. Thereafter, a “Save” button 518 can be selected to update theexisting clinical order according to the selector 516 chosen, tosubstitute the selected administration schedule option for the currentadministration schedule.

From the foregoing, it can be seen that the system and methods of thepresent invention provide for scheduling options when administrationtimes under an existing order are to be modified. These schedulingoptions may be configured to take into account certain policies relatingto a goal of maintaining some of the characteristics of a currentadministration schedule for an orderable. Additionally, graphicalrepresentations of the scheduling options may be presented along withthe current administration schedule, enabling a clinician to quicklyappreciate the differences between scheduling options.

The aforementioned system and methods have been described in relation toparticular embodiments, which are intended in all respects to beillustrative rather than restrictive. Since certain changes may be madein the aforementioned system and methods without departing from thescope hereof, it is intended that all matter contained in the abovedescription or shown in the accompanying drawing be interpreted asillustrative and not in a limiting sense.

What is claimed is:
 1. One or more non-transitory computer-readablemedia having computer-executable instructions embodied thereon that,when executed, perform a method which improves a computer process on oneor more computing devices including a control server and one or moredatabases communicating over a computer network for generatingalternative scheduling for orderable administration having a currentschedule in a clinical computing environment, the method comprising:receiving input by the control server regarding proposed timing forchanging the current administration schedule preexisting in the one ormore databases for a substance-based orderable for an individual patientassociated with an established order preexisting in the one or moredatabases after the administration of at least one dose of saidorderable; calculating by the control server based on the received inputand parameters of the current administration schedule, a plurality ofuser-selectable options for a revised administration schedule for thepatient associated with the established order, including a time for anext administration for the substance-based orderable, times for aremainder of said administration schedule, and an effective resultingvariation from the current administration schedule of each of theplurality of user-selectable option, based on a policy for maintaining adegree of commonality with the current administration schedule;automatically generating by the control server based on the calculatedplurality of user-selectable options a graphical user interfacesimultaneously displaying via a screen at least a graphicalrepresentation of each of the calculated plurality of user-selectableoptions and their associated resulting effect in response to a proposedchange of said administration schedule; receiving input by the controlserver representing a user selection of one option of the displayedplurality of user-selectable options for a revised administrationschedule; and updating the established order and the current schedule bythe control server based on the particular revised administrationschedule option indicated by the user selection.
 2. Thecomputer-readable media of claim 1, wherein the substance-basedorderable includes one of: a medication; or a non-medication chemicalagent.
 3. The computer-readable media of claim 1, wherein the policy formaintaining a degree of commonality includes one or more of: maintainingfor one or more of the plurality of user-selectable options theremaining number of doses of the substance-based orderable to beadministered under the current administration schedule associated withthe established order; maintaining for one or more of the plurality ofuser-selectable options the remaining number of doses of thesubstance-based orderable to be administered under the currentadministration schedule associated with the established order whileobserving a stop date and time for administration of the substance-basedorderable that is as close as possible to a current stop date and timeunder the current administration schedule associated with theestablished order; and observing for one or more of the plurality ofuser-selectable options a stop date and time for administration of thesubstance-based orderable that is as close as possible to a current stopdate and time under the current administration schedule associated withthe established order.
 4. The computer-readable media of claim 1,wherein the input received includes one or more of: an earliest time foradministering a dose and a number of doses per day of thesubstance-based orderable; and a set of times representing when a doseof the substance-based orderable is to be administered within a day. 5.The computer-readable media of claim 1, wherein the established orderrepresents an order where a first dose administration has either alreadyoccurred or is planned for occurrence.
 6. The computer-readable media ofclaim 1, wherein the step of determining the plurality ofuser-selectable options for a revised administration schedule associatedwith the established order includes: determining the next two doseoptions for substance-based orderable administration under a proposedadministration schedule according to the input received; determining thestop date and time for substance-based orderable administration underthe proposed administration schedule that is closest in time to a stopdate and time for substance-based orderable administration under thecurrent administration schedule associated with the established order;and if the next two dose options are both past the stop date and timefor substance-based orderable administration under currentadministration schedule, then designating only a first dose option ofthe next two dose options as a valid option for the revisedadministration schedule, wherein the stop date and time forsubstance-based orderable administration under the proposedadministration schedule is utilized for the first dose option, else,designating both a first and a second dose option of the next two doseoptions as valid options for the revised administration schedule,wherein the stop date and time for substance-based orderableadministration under the proposed administration schedule is utilizedfor the first dose option.
 7. The computer-readable media of claim 6,wherein the step of determining the plurality of user-selectable optionsfor a revised administration schedule associated with the establishedorder further includes: determining, when only the first dose option ofthe next two dose options is designated as the valid option for therevised administration schedule, if a number of doses of thesubstance-based orderable under the first dose option for the revisedadministration schedule is equal to the number of remaining doses of thesubstance-based orderable on the current administration schedule;wherein if such an equal number of doses exists, then designating thefirst dose option as an option for the revised administration schedulewhere the remaining number of doses of the substance-based orderable tobe administered under the current administration schedule is maintainedwhile observing a stop ‘date and time for administration of thesubstance-based orderable that is as close as possible to the currentstop date and time- under the current administration schedule, else:determining another stop date and time for substance-based orderableadministration under the first dose option that maintains the remainingnumber of doses of the substance-based orderable to be administeredunder the current administration schedule, thereby forming a modifiedfirst dose option, designating the modified first dose option as anoption for the revised administration schedule where the remainingnumber of doses of the substance-based orderable to be administeredunder the current administration schedule is maintained, and, based onthe value of the number of doses of the substance-based orderable underthe first dose option for the revised administration schedule,selectively designating the first dose option as an option for therevised administration schedule that observes a stop date and time foradministration of the substance-based orderable that is as close aspossible to the current stop date and time under the currentadministration schedule.
 8. The computer-readable media of claim 6,wherein the step of determining the plurality of user-selectable optionsfor a revised medication administration schedule associated with theestablished order further includes: determining, when both the firstdose option and the second dose option of the next two dose options aredesignated as valid options for the revised administration schedule, ifa number of doses of the substance-based orderable under the first doseoption and the second dose option for the revised administrationschedule are equal to the number of remaining doses of thesubstance-based orderable on the current administration schedule;wherein if such an equal number of doses exists for the first doseoption, then designating the first dose option as an option for therevised administration schedule where the remaining number of doses ofthe substance-based orderable to be administered under the currentadministration schedule is maintained while observing a stop date andtime for administration of the substance-based orderable that is asclose as possible to the current stop date and time under the currentadministration schedule, else: determining another stop date and timefor medication administration under the first dose option that maintainsthe remaining number of doses of the substance-based orderable to beadministered under the current administration schedule, thereby forminga modified first dose option, designating the modified first dose optionas an option for the revised administration schedule where the remainingnumber of doses of the substance-based orderable to be administeredunder the current administration schedule is maintained, based on thevalue of the number of doses of the substance-based orderable under thefirst dose option for the revised administration schedule, selectivelydesignating the first dose option as an option for the revisedadministration schedule that observes a stop date and time foradministration of the substance-based orderable that is as close aspossible to the current stop date and time under the currentadministration schedule; and if such an equal number of doses exists forthe second dose option, then designating the second dose option as anoption for the revised administration schedule where the remainingnumber of doses of the substance-based orderable to be administeredunder the current administration schedule is maintained while observinga stop date and time for administration of the substance-based orderablethat is as close as possible to the current stop date and time under thecurrent administration schedule, else: determining another stop date andtime for medication administration under the second dose option thatmaintains the remaining number of doses of the substance-based orderableto be administered under the current administration schedule, therebyforming a modified second dose option, designating the modified seconddose option as an option for the revised administration schedule wherethe remaining number of doses of the substance-based orderable to beadministered under the current administration schedule is maintained,based on the value of the number of doses of the substance-basedorderable under the second dose option for the revised administrationschedule, selectively designating the second dose option as an optionfor the revised administration schedule that observes a stop date andtime for administration of the substance-based orderable that is asclose as possible to the current stop date and time under the currentadministration schedule.
 9. The computer-readable media of claim 1,wherein the graphical representation of the plurality of user-selectableoptions includes a set of display objects for each option, each displayobject presented in a context to indicate a date and time for eachadministration for the substance-based orderable under the respectiverevised administration schedule option.